Uncomplicated Phacoemulsification Research Articles

Transient Macular Edema after Uncomplicated Cataract Surgery: Below the Surface

To present analysis of 17 case reports of 17 patients who had an acute transient macular edema appeared after uneventful cataract surgery. Observations: In literature about 12 case series of toxic macular edema development after cataract surgery are described and all of them were accompanied by the cefuroxime intracameral usage. Also, there are reports of macular edema development after several weeks after uncomplicated phacoemulsification due to pseudophakic cystoid macular edema (Irvine-Gass syndrome) or due to vitreomacular traction syndrome. We observed a series of transient acute macular edema with 3,8% incidence occurring on the first days after uncomplicated phacoemulsification with IOL implantation that had no signs of vitreomacular traction or acute inflammation. Optical coherence tomography (OCT) was performed on patients complaining on blur vision and who had signs of macular edema by ophthalmoscopy. By OCT high and often extensive neuroepithelium and local pigment epithelium detachments were observed on the first day after surgery in 17 patients with quiet postoperative condition of the eye. The edema resolved on the 3-6-th day by standard phaco accompanying pharmacological treatment. In most cases posterior vitreous cortex was adjacent to the retina except 3 patients with posterior vitreous detachment in macular area. We found a paper by Costen M.T.J. et al. (2007) about the same striking appearance of maculopathy called by authors “A-sign” maculopathy because of A-shaped pattern on OCT images in 3 patients after routine cataract surgery. Yaman A (2008) and Panagiotidis D (2010) also reported same findings after uncomplicated cataract surgery. We compared our findings with 3 papers mentioned above, as well as with typical pseudophakic cystoid macular edema (CME) and vitreomacular traction syndrome. Conclusion: It’s obvious that observed case series are cefuroxime induced. But its comparison with CME in terms of morphology of the macula could improve our understanding of mechanisms of the interstitial fluid flow in the eye tissues.

Stereoacuity and Aniseikonia: Evaluation Before and After Bilateral Implantation of Three Types of Presbyopia-Correcting Intraocular Lenses in Uncomplicated Phacoemulsification with Due Consideration of Interocular Differences in Higher Order Aberrations, Axial Lengths, Refractive Errors, and Acuities

Stereoacuity and Aniseikonia: Evaluation Before and After Bilateral Implantation of Three Types of Presbyopia-Correcting Intraocular Lenses in Uncomplicated Phacoemulsification with Due Consideration of Interocular Differences in Higher Order Aberrations, Axial Lengths, Refractive Errors, and Acuities

Evaluation of endothelial cell loss after cataract surgery in patients with pseudoexfoliative syndrome

Introduction: Despite modern techniques and technologies for cataract surgery, pseudoexfoliative syndrome poses a challenge to surgeons due to weakness of the zonular apparatus and limited pupillary dilation. Quantitative and qualitative morphological changes in the corneal endothelium have been demonstrated by several studies. An accumulated risk of endothelial cell loss can be expected in these patients following more complicated and prolonged surgery, often requiring complex manipulation of the cataract, iris, and IOL. Our present work aims to compare the loss of endothelial cells after uncomplicated phacoemulsification in patients without and with pseudoexfoliative syndrome. Materials and methods: We conducted a prospective comparative study collected at the Rabat specialty hospital, spanning from August to December 2023. Were included in this study 60 candidates for cataract surgery: - 30 patients with pseudoexfoliation syndrome (PXF) and - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. Discussion: In our series, we did not find a statistically significant difference in the density of preoperative endothelial cells between the 2 groups, this result is similar to that obtained by KALJURAND et al, on the other hand for ken hayashi et al, and wirbelauer et al, the difference between the 2 groups was statistically significant. Regarding postoperative cell loss, our results agreed with those obtained by Ken Hayashi et al, who also reported greater endothelial cell loss in the PXF group compared to the control, unlike Wirbelauer et al, for whom the loss of endothelial cells was similar between the 2 groups. In the study by Kaljurand et al, the average percentage loss was 18% in the PXF group versus 11.6 in the control group, this difference had a statistically low significance. Conclusion: The loss of corneal endothelial cells after phacoemulsification in eyes with capsular pseudoexfoliation was significantly greater than in eyes without PXF, these results suggest that corneal endothelial cells of patients with pseudoexfoliation syndrome are more vulnerable to cataract surgery than healthy endothelial cells. To prevent serious endothelial lesions, a precise preoperative evaluation of the corneal endothelial state by specular microscopy seems necessary in these patients, with more precision and precautions during the procedure.

Comparison of IOL power formulas in eyes with a flat cornea

PurposeTo assess and compare accuracy of intraocular lens (IOL) power calculation performed with old generation, new generation and artificial intelligence (AI)-based formulas in eyes with flat corneas. DesignPatients with a tomography-derived mean keratometry <42 D were retrospectively recruited among those who underwent uncomplicated phacoemulsification with intracapsular IOL implantation in two different tertiary care centers. Mean prediction error (ME), mean absolute prediction error (MAE) and incidence of MAE>0.25D were calculated for Barrett Universal II (BUII),EVO 2.0, Hoffer QST, Kane, Olsen-C, Pearl-DGS and SRK/T formulas. Linear correlation between MAE and axial length was also calculated for each formula. ResultsEighty (80) eyes with a mean keratometry of 41.4 ± 0.6 D (range 40.6–41.9 D) were recruited. The SRK/T significantly differed from both the Olsen-C (p = 0.022) and the BUII (p = 0.048) in ME. The EVO 2.0, the Hoffer QST, the Kane and the PEARL-DGS showed a significantly lower MAE compared to all other formulas (p < 0.001) and a significant lower incidence of MAE>0.25D (p < 0.001), MAE>0.50 D (p < 0.001) and MAE>1.0 D (0.002). ConclusionFormulas based on AI and on the theory of vergence show superior accuracy in IOL power calculation in corneas with low mean keratometry; their MAE is not correlated to axial length.

The effect of sodium hyaluronate on dry eye and corneal epithelial thickness following cataract surgery.

To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery. The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1week and 1month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared. A statistically significant difference was determined between the two groups at postoperative 1month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1week (p < 0.01) and preoperative values were reached at 1month postoperatively. In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium.

TEAR FILM CHANGES FOLLOWING PHACOEMULSIFICATION SURGERY IN PRIMARY EYE CARE CENTER

Abstract&#x0D; Introduction &amp; Objectives : Dry eye disease (DED) is one of the most commonly encountered problem in daily ophthalmology practice. One of many risk factors for DED is cataract surgery. Cataract surgery is known to modify tear film and ocular surface through corneal incision and ocular toxicity of peri- and postoperative medications. The aim of this study is to analyze tear film before and after phacoemulsification in primary eye care facility by measuring tear break-up time (TBUT), fluorescein staining, Schirmer I test (ST-I), and ocular surface disease index (OSDI) score.&#x0D; Methods : This was a longitudinal observational study with prospective cohort design, which included patients diagnosed with senile cataract and underwent uncomplicated phacoemulsification surgery at primary eye care center Sawangan Eye Clinic within period of June to December 2022. Friedman, Wilcoxon, and Cochran tests were used to analyze the data.&#x0D; Results : Thirty nine eyes from 39 patients met the inclusion criteria and were followed up to 3-month postoperatively. Mean age of the patients was 61.1±10.54 years, which consited of 53.8% males and 46.2% females. Mean preoperative OSDI score, corneal staining, TBUT, and ST-I were 24.94±10.24, 1.38±1.99, 2.94±2.17, and 15.46±8.80 respectively; while 3-month postoperative, these parameters’ means were 11.22±13.15 (p=0.0001), 1.38±2.56 (p=0.118), 3.13±1.79 (p=0.192), and 13.31±9.45 (p=0.006) respectively. OSDI was the only parameter which showed statistically significant changes from preoperative to postoperative follow ups (p&lt;0.05).&#x0D; Conclusion : Phacoemulsification did not alter corneal staining and TBUT significantly after 3 months postoperatively, even though both of these parameters' preoperative value were already lower; yet OSDI score improved over time after surgery.

Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation

In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5–20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.

Anterior chamber flare and choroidal vascular index as inflammatory markers after uncomplicated phacoemulsification surgery.

To determine the effect of phacoemulsification surgery, which is one of the types of cataract surgery by using ultrasonic power to break up the crystalline lens and clean it with vacuum, on anterior chamber flare (ACF) and choroidal vascular index (CVI). For this cross-sectional study, patients were included if they had cataract with nucleus hardness grade 2 or 3, no systemic inflammatory disease, and not use of anti-inflammatory drugs/prostaglandins preoperatively. ACF using a laser flare meter and CVI in patients underwent uncomplicated phacoemulsification was recorded preoperatively, on the postoperative 1st day, 1st week, and 1st month. Fifty-six eyes were included. ACF was 9.00 ± 2.90 ph/ms preoperatively. Although ACF increased significantly on postoperative day-1 (39.38 ± 23.31ph/ms) and decreased gradually until the 1st month (14.03 ± 6.03ph/ms) after the operation, it was still significantly higher at the 1st month (p < 0.001). Macular and peripapillary CVI increased significantly on postoperative day-1 (0.64 ± 0.03/0.63 ± 0.05) and week-1 (0.64 ± 0.04/0.62 ± 0.04) (p = 0.01, p < 0.001); the postoperative 1st month was similar to the preoperative one (0.59 ± 0.06/0.58 ± 0.06). The relationship between the change in ACF and the change in CVI was not significant. Phacoemulsification causes raises in ACF and CVI due to increased intraocular inflammation. The fact that ACF was significantly higher in postoperative month-1 and CVI returned to its preoperative value suggests that the effect of uncomplicated phacoemulsification surgery on the increase in inflammation in the anterior segment lasts longer than in the posterior segment. These results suggest that ACF and CVI follow-up may be clinically important in the follow-up of postoperative inflammation.

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis.

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using theGrading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Progression of diabetic retinopathy following uncomplicated phacoemulsification: A prospective study from South India.

The aim of this study was to study the progression of diabetic retinopathy (DR) and macular edema in uncomplicated phacoemulsification in patients with diabetes mellitus with a follow-up of 6 months. A prospective, nonrandomized study was conducted on patients with established or no DR in a known case of diabetes mellitus undergoing cataract surgery by phacoemulsification, with no intraoperative complications. Detailed ophthalmic evaluation including fundus examination was done in all cases, and DR staging was done. Optical coherence tomography and fundus fluorescein angiography were done in indicated cases. Fundus evaluation was done during the follow-up visits in 3 weeks, 3 months, and 6 months postsurgery and the tests were repeated if necessary. In the current study, there was a statistically significant improvement in best-corrected visual acuity after cataract surgery compared to the preoperative value. From the 330 eyes we analyzed, there was a progression of DR in only 18 eyes (5.45%) following phacoemulsification. There was a statistically significant increase in central macular thickness (CMT) at 3 weeks postoperative (433.82 ± 137.572) compared to that of the preoperative CMT (295.98 ± 97.959). From the 22 eyes which showed a progression of diabetic maculopathy, 11 eyes had developed new-onset macular edema following the cataract surgery, 11 eyes had progression of preexisting edema, and 4 of them had to undergo intravitreal anti-vascular endothelial growth factor injections as the treatment. The chance of progression of DR staging is low after uncomplicated phacoemulsification, on a short term. However, the chances of worsening of macular edema as well as worsening of proliferative stages should be kept in mind while advising a patient for cataract surgery.

Effect of intracameral injection of ceftazidime on corneal endothelium by specular microscope after uncomplicated phacoemulsification cataract surgery

Background Loss of endothelial cells is inevitable after cataract surgery. Therefore, it is critical to protect the corneal endothelium during cataract surgery to reach good visual outcomes afterward. Maintenance of corneal clarity depends on the good function of healthy endothelial cells in addition to an intact pumping system intended to remove fluid from the corneal stoma. Purpose Our study aimed to assess changes in the corneal endothelium using specular microscopy, after intracameral injection of ceftazidime in uncomplicated phacoemulsification and compared with a placebo. The changes were measured preoperatively and 1 month postoperatively. Patients and methods Our prospective cohort study comprised 40 eyes from 35 patients diagnosed with cataract, all of whom underwent uncomplicated phacoemulsification for cataract extraction. Results Endothelial cell density significantly decreased postoperatively compared with preoperative values in both groups. Central thickness of the cornea, coefficient of variation, and visual acuity significantly increased postoperatively compared to preoperative values in both groups. Endothelial cell density showed a significant decrease postoperatively with a P value equal to 0.01 for group A (placebo group) and 0.02 for group B (ceftazidime group). Central thickness of the cornea, coefficient of variation, and visual acuity showed significant increases postoperatively with a P value equal to 0.026, 0.005, and 0.001 for group A and 0.001, 0.034, and 0.001 for group B, respectively. Conclusion Ceftazidime can be considered safe for corneal endothelium when used intracamerally during phacoemulsification cataract surgery for prophylaxis of postoperative endophthalmitis.

Oj boli, boli, czyli ból w okresie okołooperacyjnym chirurgii soczewki

Pain and anesthesia are important parts of the perioperative management of patients undergoing cataract surgery. They affect the quality of life and the readiness to undergo another procedure. The level of anxiety, pain, and it’s intensity occur with different frequencies. The group of patients who underwent uncomplicated phacoemulsification cataract surgery under local anesthesia and intravenous sedation was asked to complete an anonymous questionnaire, taking into account several factors such as age, gender, level of education, level of anxiety before surgery, nature of pain, previous procedures, general diseases and other. The study aims to compare the frequency and intensity of perioperative pain during first and second eye surgery and to list predisposing factors to pain during cataract surgery.

Macular changes following cataract surgery in eyes with early diabetic retinopathy: an OCT and OCT angiography study.

To evaluate changes in macular status and choroidal thickness (CT) following phacoemulsification in patients with mild to moderate nonproliferative diabetic retinopathy (NPDR) using optical coherence tomography. In this prospective study, all of the patients underwent uncomplicated phacoemulsification. Retinal superficial capillary plexus vascular density (SCP-VD), macular thickness (MT), and CT were measured pre- and postoperatively. Twenty-two eyes of 22 cataract patients with mild to moderate NPDR without diabetic macular edema (DME) and 22 controls were enrolled. BCVA increased in two groups at 3 months postoperatively. At 1 and 3 months postoperatively, SCP-VD in the diabetic retinopathy (DR) group significantly increased; changes in SCP-VD in parafovea were significantly greater in the DR group than in the control group. MT and CT in the DR group significantly increased at all visits postoperatively in the fovea and perifovea. Changes in parafoveal MT were significantly greater in the DR group than in the control group at all visits postoperatively. Changes in CT and MT in the fovea were significantly greater in patients with DR than in the controls 1 and 3 months postoperatively. Uncomplicated phacoemulsification resulted in greater increases in SCP-VD, MT and CT in patients with early DR without preoperative DME than in controls.

A comparative study of central macular thickness and endothelial cell changes in patients with diabetes mellitus undergoing phacoemulsification.

One of the most prevalent causes of blindness worldwide is cataracts. Along with the lens, Diabetes mellitus can impact all ocular structures. Diabetics have a higher incidence of cataract formation due to a variety of reasons. Diabetic people may have thicker corneas. The most frequent reason for poor vision recovery after surgery is macular edema, which is caused by cataract surgery. Therefore, after phacoemulsification, we are measuring the central macular thickness and central corneal thickness in diabetics in order to observe the post phacoemulsification macular edema and any significant changes in corneal thickness. We expect a morphological changes in endothelial cells, increase central corneal thickness and increase central macular thickness post-operatively after uncomplicated phacoemulsification surgery.

The Influence of Biometric Factors on Refraction Post Uncomplicated Phacoemulsification: About 86 Cases

Aim: to evaluate the biometric factors that influence the refraction obtained after simple phacoemulsification using the SRK/T formula. Methods: This is a prospective study of 86 eyes subjected to cataract surgery during a one-year period. The biometric factors evaluated include axial length, keratometry, lens thickness, anterior chamber depth and vitreous depth. The implant calculation formula employed was SRK/T, which is a commonly used method. All patients underwent phacoemulsification and implantation of a foldable intraocular lens into the capsular bag. Refraction was measured 30 days after surgery. Results: the mean axial length was 23.16±0.53mm, mean K1 was 43.5±1.50D, mean K2 was 43±1.63D, mean anterior chamber depth was 3.03mm, mean lens thickness was 3.37mm, mean postoperative target refraction was 0.16±0.377D, and mean postoperative refraction obtained was -0.226±0.625D. Among the eyes, 18.92% had a postoperative refraction within ±0.5D, and a non-target refraction outside ±0.5D was found in 64 eyes. In addition, 30.23% of the eyes had a postoperative refraction within ±0.75D. Conclusion: the SRK/T formula seems to be a dependable method for predicting postoperative refraction following cataract surgery. However, the accuracy of this prediction may be influenced by the axial length of the eye. Higher axial lengths are associated with a greater tendency towards myopia.

Closure of a Chronic Traumatic Macular Hole Following Phacoemulsification Surgery.

To report a case of chronic traumatic macular hole closure following an uncomplicated phacoemulsification surgery. Retrospective chart review with optical coherence tomography imaging. 42-year-old woman with a 20-year history of a traumatic macular hole and cataract in the right eye underwent an uncomplicated phacoemulsification surgery. Following surgery, the patient was prescribed prednisolone acetate 1% four times per day, which was tapered off by postoperative month 1. By postoperative month 1, the full-thickness macular hole had closed. This unique case illustrates the closure of a full-thickness macular hole following cataract surgery. We hypothesize that closure of the macular hole was aided by the use of topical steroids in the postoperative period, allowing for resolution of the cystic intraretinal fluid and hole closure.

The effects of non-prostaglandin hypotensive drops with preservative on central retinal thickness after phacoemulsification

BACKGROUND: Primary open angle glaucoma is often associated with cataract. The correlation between the use hypotensive drops, in particular non-prostaglandin hypotensive drops with preservative, and the change in central retinal thickness after phacoemulsification with intraocular lens implantation continues to be relevant.&#x0D; AIM: To evaluate central retinal thickness and pseudophakic cystoid macular edema incidence after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservatives.&#x0D; MATERIALS AND METHODS: 94 patients (108 eyes) with cataract were enrolled in the study, divided into 3 groups: the first group 21 patients (27 eyes), and the second group 21 patients (23 eyes) with primary open-angle glaucoma using non-prostaglandin hypotensive drops with preservative; the third (control) group included 52 patients (58 eyes) without ocular comorbidities. All patients underwent uncomplicated phacoemulsification with intraocular lens implantation. In the post-op period, patients of the first group received topical antibiotics and steroids, patients of the second and the third groups received the same treatment and non-steroidal anti-inflammatory drops as well. Central retinal thickness was measured using optical coherence tomography before surgery, 2 weeks, 2 and 6 months after surgery.&#x0D; RESULTS: The central retinal thickness increase in comparison with baseline values was more significant in the first group than in the second and the third groups, and the time of recovery to baseline values during 6 months after surgery was longer. Pseudophakic cystoid macular edema was not identified in any group.&#x0D; CONCLUSIONS: The use non-prostaglandin drops with preservative in patients with primary open-angle glaucoma does not affect pseudophakic cystoid macular edema development after uncomplicated phacoemulsification. Instillations of non-steroidal anti-inflammatory drops in the post-op period reduce the time of central retinal thickness recovery to baseline value.

Effects of Intra-cameral Dexamethasone after Uncomplicated Phacoemulsification

Purpose: Postoperative inflammation is very common following phacoemulsification. We conducted this study to compare the effectiveness of intra-cameral dexamethasone injection with traditional topical steroids following phacoemulsification. Study Design: Quasi experimental Place and Duration of Study: Jinnah Postgraduate Medical Center, JPMC, Karachi from February 2022 to July 2022. Methods: A total of 60 patients were divided into two equal groups of 30 each. One group was treated with prophylactic intra-cameral dexamethasone at the end of phacoemulsification and the other group was given Balanced Salt Solution in its place. Both the groups were examined at post-operative day 1 and 7 for following parameters; best corrected visual acuity (BCVA), intra-ocular pressures (IOP), anterior chamber cells and flare. Results: The dexamethasone group showed statistically significant improvement in anterior chamber cells and flare as compared to the placebo group at postoperative day 1 and 7 (p-value of 0.042 and 0.029 respectively for cells; p-value of 0.038 and 0.002 respectively for flare). HoweverBCVA and IOP showed no statistically significant differences between the two groups at postoperative day 1 and 7 (p-value 0.67 and 0.46 respectively for BCVA and 0.22 and 0.08 respectively for IOP). Conclusion: Intra-cameral dexamethasone is an effective way to control postoperative inflammation following phacoemulsification with reduced anterior chamber cells and flare. However, its effects on BCVA and IOP were comparable to topical steroids.

Early Postoperative Changes in Macular Choroidal Thickness After Uncomplicated Phacoemulsification in Patients With and Without Glaucoma: A Swept-Source Optical Coherence Tomography Study.

Purpose The objective of this study was to examine the impact of uncomplicated phacoemulsification on macular choroidal thickness (CT) within the first three postoperative months and to investigate its relationship with postoperative cystoid macular edema (CME) in both glaucomatous and healthy subjects, utilizing swept-source optical coherence tomography (SS-OCT). Methods The non-randomized prospective study involved 82 patients, selected via convenience sampling from the First Department of Ophthalmology, Medical School of Athens, "G. Gennimatas" Hospital, Athens, Greece, between May 2018 and May 2022, undergoing phacoemulsification and intraocular lens (IOL) implantation. The inclusion criteria encompassed patients aged 50 years or above, with or without glaucoma. Patients with ocular pathologies that could influence macula or CT measurements were excluded. Data collection focused on retinal and CT variablesof the macular area, measured using SS-OCT. Baseline measurements were established preoperatively, with follow-up assessments at one week, one month, and three months postoperatively to monitor CT and macular edema onset. Results A total of 82 eyes from 82 patients with a mean age of 79.1±8.3 years were included. The study population was divided into a glaucoma group (n=28 eyes) and a control group (n=54 eyes). Our findings indicate a consistently significant increase in macular CT measurements one month after cataract surgery, observed in both glaucomatous and non-glaucomatous eyes. In the first postoperative week, statistically significant changes in CT were observed only in patients with CME. Subsequently, at one-month interval, both patient groups, those with and without CME, exhibited statistically significant changes in CT across all macular sectors. CME was detected in 10 out of 28 eyes in the glaucoma group and in 16 out of 54 eyes in the control group. When evaluating the impact of postoperative CME on groups of glaucomatous and non-glaucomatous eyes, it was observed that glaucomatous eyes exhibited a significantly larger magnitude of change in subfoveal CT (SFCT) (p=0.03) at one month (relative to baseline) compared to non-glaucomatous eyes. There was also a 31% increase in the odds of developing CME for glaucoma patients; this result was not statistically significant (odds ratio {OR}, 1.31; 95% confidence interval {CI}, 0.50-3.47; p=0.57). Conclusions During the early postoperative period, the study revealed a significant increase in CT at one month after phacoemulsification in both glaucomatous and non-glaucomatous eyes. When CME was present, a significantly more pronounced magnitude of change in SFCT was observed at one month in glaucomatous eyes, as opposed to non-glaucomatous eyes. This observation suggests a possible selective susceptibility of glaucomatous eyes in the early postoperative period that requires further research.

Evaluation of the corneal thickness and endothelial changes following uncomplicated phacoemulsification in diabetic and non-diabetic patients with pseudo-exfoliation syndrome by specular microscopy.

To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX. This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT. By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction. Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications. The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).